Purpose To compare 2.0 mg ranibizumab (RBZ) injections with 0.5 mg RBZ for eyes with center-involved diabetic macular edema (DME) and a central subfield thickness (CFT) of ≥ 250 μm on time-domain optical coherence tomography. Design Randomized, controlled, multicenter clinical trial. Methods Eligible eyes were randomized in a 1:1 ratio to 0.5 mg (n = 77) or 2.0 mg (n = 75) RBZ. Study eyes received 6-monthly injections. Main outcome measures The primary outcome measure was the mean change in best corrected visual acuity (BCVA) at month 6. Secondary outcomes included the incidence and severity of systemic and ocular adverse events and the mean change in CFT from baseline. Results In all, 152 eyes (152 patients) were randomized in the study. At month 6, the mean improvement from baseline BCVA was +9.43 letters in the 0.5 mg RBZ group and +7.01 letters in the 2.0 mg RBZ group (P = 0.161). At month 6, one death occurred in the 0.5 mg RBZ group and three deaths in the 2.0 mg RBZ group, all due to myocardial infarction in subjects with a prior history of heart disease. Mean CFT was reduced by 168.58 μm in the 0.5 mg RBZ group and by 159.70 μm in the 2.0 mg RBZ group (P = 0.708). Conclusions There was no statistically significant difference in the mean number of letters gained between the 0.5 and 2.0 mg RBZ groups through month 6. In this DME study population, high-dose RBZ does not appear to provide additional benefit over 0.5 mg RBZ.

Objective: To evaluate the safety and efficacy of Suprachoroidal Triamcinolone Acetonide (SCTA) injection in patients with treatment resistant Diabetic Macular Edema (DME). Methods: This was a prospective non randomized interventional study conducted in the vitreoretinal department of Al Ehsan Welfare Eye Hospital, Lahore, Pakistan from March 2018 to September 2018. A total of 24 eyes of 24 patients were included. Baseline Best Corrected Visual Acuity (BCVA), Intra Ocular Pressure (IOP) and Central Subfield Thickness (CST) was recorded. After SCTA, patient was followed up at one and three months and same clinical parameters were recorded again and results analyzed. Results: Out of 24 patients, 11(45.83%) were males and 13(54.16%) were females. Mean pre injection CST was 636.5 ± 200.11 um. Mean pre injection BCVA was 0.8 ± 0.24 on ETDRS chart. Mean post injection CST at one and three months was 304.54 ± 67.43 and 302.66 ± 66.93 um. Mean post injection BCVA at one and three months was 0.47 ± 0.3 and 0.45 ± 0.27 on ETDRS chart. The results were statistically significant for pre and post injection CST at both one and three months (p-value < 0.00001). Pre and post injection BCVA was also statistically significant (p-value < 0.05). Conclusion: Preliminary evidence suggests that SCTA is well tolerated and may help in improving functional and structural outcomes of treatment resistant DME. doi: https://doi.org/10.12669/pjms.36.2.1194 How to cite this:Tayyab H, Ahmed CN, Sadiq MAA. Efficacy and safety of suprachoroidal triamcinolone acetonide in cases of resistant diabetic macular edema. Pak J Med Sci. 2020;36(2):42-47. doi: https://doi.org/10.12669/pjms.36.2.1194 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: To evaluate the safety and efficacy of Suprachoroidal Triamcinolone Acetonide (SCTA) injection in patients with treatment resistant Diabetic Macular Edema (DME). Methods: This was a prospective non randomized interventional study conducted in the vitreoretinal department of Al Ehsan Welfare Eye Hospital, Lahore, Pakistan from March 2018 to September 2018. A total of 24 eyes of 24 patients were included. Baseline Best Corrected Visual Acuity (BCVA), Intra Ocular Pressure (IOP) and Central Subfield Thickness (CST) was recorded. After SCTA, patient was followed up at one and three months and same clinical parameters were recorded again and results analyzed. Results: Out of 24 patients, 11(45.83%) were males and 13(54.16%) were females. Mean pre injection CST was 636.5 ± 200.11 um. Mean pre injection BCVA was 0.8 ± 0.24 on ETDRS chart. Mean post injection CST at one and three months was 304.54 ± 67.43 and 302.66 ± 66.93 um. Mean post injection BCVA at one and three months was 0.47 ± 0.3 and 0.45 ± 0.27 on ETDRS chart. The results were statistically significant for pre and post injection CST at both one and three months (p-value < 0.00001). Pre and post injection BCVA was also statistically significant (p-value < 0.05). Conclusion: Preliminary evidence suggests that SCTA is well tolerated and may help in improving functional and structural outcomes of treatment resistant DME. doi: https://doi.org/10.12669/pjms.36.1.1194 How to cite this:Tayyab H, Ahmed CN, Sadiq MAA. Efficacy and safety of suprachoroidal triamcinolone acetonide in cases of resistant diabetic macular edema. Pak J Med Sci. 2020;36(1):---------. doi: https://doi.org/10.12669/pjms.36.1.1194 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.